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CISM

Critical Incident Stress Management

A comprehensive, integrated, systematic and multi-tactic approach to manage critical incident stress after traumatic events. CISM is a coordinated program of tactics that are linked and blended together to alleviate the reactions to traumatic experiences. (Jeffrey Mitchell, PhD, CTS)

Novant Health CISM Team (Critical Incident Stress Management)


  • Resulted from a recommendation following a root cause analysis of a sentinel event
  • Identified the need for a systematic response to workplace trauma throughout the organization
  • Led to the establishment of a multidisciplinary Steering Committee to address this need

What Constitutes a Critical Incident?


An episode of death, injury, threat or excessive burden that typically is unforeseen and traumatizes the workforce to the point of jeopardizing the individual and collective sense of well-being. Some examples where a CISM team would become involved include:

  • Death of an employee
  • Natural disaster affecting employees
  • Death of long-term patient

Principal Goals of CISM Interventions


  • To reduce emotional tension and distress
  • To facilitate the normal recovery process of people having normal, healthy reactions to abnormal events
  • To identify individuals who might need additional support/attention or referral for professional care

Longer Term Impact of CISM Team


  • Improved employee morale and retention
  • Decreased chance of destructive coping (alcohol, drugs, compulsive behaviors)
  • Prevention, decreased intensity or earlier intervention for psychological disorders (acute stress disorder, PTSD, panic attacks, depression)

How it works (activating the CISM Team)


  • Anyone can call the EAP at 800/828-2778 to report or discuss a traumatic event.
  • A regional CISM coordinator will speak with the manager to strategize an appropriate response and time frame
  • 2-3 trained CISM team members will provide group and individual interventions either on-site or at an agreed-upon location typically within 24-72 hours of the incident
  • Follow-up and individual referral will be provided as needed

Leader’s Role


  • Work with CISM Coordinator to determine type, size, location, timing and number of interventions to be scheduled
  • Provide appropriate coverage to allow attendance for those who wish to participate
  • Recognize those (individual or group) that need additional services to aid the recovery process
  • Make the call early. CISM intervention looses effectiveness if too much time lapses between the event and arrival of the team.
  • Support the process in word and in deed

What does a CISM look like?


When a CISM team is activated two or three team members go to a mutually established area in proximity to employees. Team members can come from a variety of backgrounds including counseling, chaplaincy, clinical and non-clinical staff. Sessions are confidential and participants are asked to maintain confidentiality. CISM sessions may look different depending on the situation but follow specific protocols. No employee is forced to attend. CISM team members may meet with groups of employees or one on one with staff. Often the team will “round” to tell people they are present and available. Team members monitor the situation to determine how staff is managing the impact of the event. Resources are provided for employees who may need counseling and support after the event.  

To Contact or Activate the CISM Team
Call the Employee Assistance Program
800 - 828 - 2778

Stress Management Tips


  • Care for yourself by eating well, exercising, and resting when needed. Avoid stimulants such as caffeine, chocolate and nicotine and depressants such as alcohol.
  • Seek out comfortable, familiar surroundings and avoid spending too much time alone.
  • Share your thoughts and feelings with those who are supportive and helpful – don’t try to block recollections. It helps to talk about them. Feel free to set boundaries with people who have not been helpful in the past.
  • Don’t be anxious if reactions from past traumas re-emerge even though you may have felt those issues were resolved.
  • Give yourself time to recover. Difficulties with concentration, memory or decision-making are common but short-term reactions. Seek help if reactions are interfering with job responsibilities. Focus on concrete, easily-achievable tasks.
  • Remember that difficulty sleeping, nightmares, flashbacks, and feelings of being “hyper-alert” are common and will diminish in time.
  • Avoid personalizing or taking responsibility for how others respond to the traumatic event. Do not compare or measure your reactions to those of other people – each individual’s experience is unique and personal.
  • Communicate your feelings clearly. Others may not know how to respond to you appropriately. Let them know which responses are helpful and which are not.
  • Know that anniversary dates or specific holiday may trigger feelings related to the trauma. This is normal.
  • Seek help from a professional counselor if symptoms persist.

Common Reactions to Trauma


Physical Response


  • Change in sleep patterns
  • Change in appetite
  • Shallow, rapid breathing
  • Dizziness
  • Headaches
  • Muscle Tension
  • Increased heart rate
  • Stomach upset

Emotional Responses


  • Shock or numbness
  • Anger towards others involved
  • Fear
  • Depression
  • Guilt/Frustration
  • Sadness
  • Felling unsafe or vulnerable
  • Loneliness

Mental Responses


  • Confusion
  • Difficulty concentrating
  • Difficulty remembering details of event

Behavioral Responses


  • Withdrawal from others
  • Angry outbursts
  • Crying
  • Irritability
  • Decreased energy/ambition
  • Marital/relationship conflict
  • Increased use of alcohol or medications
  • Fear of being alone